The Townsville Hospital
The Townsville Hospital
News Article | April 20, 2017
Researchers hope to reduce unnecessary CT scans and radiation exposure in children with head injuries, following the results from a large-scale, multicentre validation study to assess the diagnostic accuracy of three clinical decision rules used by emergency doctors. Head injuries are one of the most common reasons children are taken to emergency departments. To rule out a serious brain injury, a percentage of these children require a CT scan and while this process is obvious for serious head injuries, it's more challenging to determine whether CT scans are necessary for children with milder injuries. The results from the Australasian clinical trial will help inform the use of the clinical decision rules for head injuries, which in turn could minimise CT scans, according to Lead investigator, Murdoch Children's Research Institute's Associate Professor Franz Babl. "The aim of this study was to determine which children need CT scans to detect brain injury," said A/Prof Babl. "Most head injuries are mild and don't require neurosurgical management, however, a small proportion of patients might present as having mild injuries, but have clinically significant intracranial injuries," he said. "This can be a vexed issue because physicians need to balance the importance of diagnosing an injury with reducing radiation exposure as much as possible. "The preferred course of treatment is to avoid a CT scan in minor head injuries if it is unnecessary. In particular, there is concern about the high radiation dose associated with CT scans of the head which can lead to cancer." In these cases, clinicians can turn to clinical decision rules, which have been developed to identify children at high risk of intracranial injuries, aiming to assist clinicians to minimise CT scans while still identifying all relevant injuries. In a prospective observational study, run across 10 Australian and New Zealand tertiary hospitals and involving, 20,137 children under the age of 18 years with head injuries, the research team compared three clinical decision rules: The goal was to determine which of these three decision rules provided the best option when it came to identifying children at very low risk of a traumatic brain injury. The researchers found that all three rules were good options, but only one, the PECARN from the US, did not miss a single patient requiring neurosurgery. Based on the research findings, the next step is for the group of emergency physicians to develop national approaches to optimise the management of children with head injuries in Australia and New Zealand. Internationally, the findings will provide a useful starting point for individual clinicians as well as hospitals or regional bodies contemplating the introduction or modification of one of the clinical decision rules, according to A/Prof Babl. "However, it will be important to relate the findings to a number of other factors before implementation, such as the baseline CT use, the effect of the rules on the projected CT rate, the baseline clinician diagnostic accuracy and experience, parental expectations, the medico-legal climate and economic considerations." The outcomes from the clinical trial were recently published in The Lancet. In The Lancet article, the researchers commented that patients reflected an Australia and New Zealand cohort from tertiary children's hospitals, which had much lower neuro-imaging rates than those reported from the USA and Canada. The study was run by clinicians involved in the PREDICT network (Paediatric Research in Emergency Departments International Collaborative). They received grants totalling AU$1.391 million from the NHMRC, the Emergency Medicine Foundation of Australia (EMF), Perpetual Philanthropic Services, Murdoch Children's Research Institute, Auckland Medical Research Foundation, A+ Trust, Auckland District Health Board, Townsville Hospital and Health Service Private Practice Research and Education Trust fund and the WA Health Targeted Research Fund. The $298,000 EMF grant, funded by Queensland Health, enabled the study to run at the Lady Cilento Children's Hospital, Brisbane and The Townsville Hospital. Other hospitals participating in the study included: Royal Children's Hospital, Melbourne; Princess Margaret Hospital, Perth; Monash Children's Hospital, Melbourne; Kidzfirst Middlemore Hospital, New Zealand; Starship Hospital, Auckland; Women's and Children's Hospital, Adelaide; and The Children's Hospital at Westmead, Sydney.
Kandasamy Y.,The Townsville Hospital
Journal of immigrant and minority health | Year: 2015
Northern Queensland is unique in that the proportion of Aboriginal and Torres Straits Islander (ATSI) communities is higher than the rest of Australia. The aim of this study was to describe the characteristics of term admissions of low birth weight (LBW; birth weight < 2,500 g) and small for gestational age (SGA; birth weight < 10th centile) infants to a neonatal unit. All term infants (>37 weeks of gestation) with LBW and/or SGA admitted to the neonatal unit over the last 10 years (2002-2011) were identified and the percentage calculated. Ethnicity was determined by the mother and that information was recorded in the patient's medical record. The average percentage of LBW ATSI infants was 20.2 ± 5.7%, which was significantly higher (almost double) compared with the percentage of LBW non-ATSI infants (10.2 ± 1.9%; p < 0.001). The average percentage of SGA ATSI infants was also significantly higher than the percentage of SGA non-ATSI infants (31.8 ± 6.0 vs. 18.6 ± 2.8%, respectively; p < 0.001). The mean percentage of LBW indigenous infants admitted to the neonatal unit was significantly higher than non-ATSI infants.
News Article | November 2, 2016
Millions of Australians suffering from kidney stones could soon get relief, with researchers discovering a prostrate treatment can also help ease the painful condition. Patients with kidney stones were treated with the drug Tamsulosin in an Emergency Medicine Foundation Australasia (EMF) funded clinical trial run across five Australian hospital emergency departments. Trial leader and specialist emergency medicine physician at The Townsville Hospital, Dr Jeremy Furyk, said Tamsulosin was normally used to treat an enlarged prostate, but the research team found the treatment could also assist the passage of large kidney stones in the urine. "Kidney stones are a bit of a mystery, occur frequently in the community and generally affect young, healthy adults," Dr Furyk said. "It can be extremely painful to pass these jagged little crystallized minerals and it's very common for sufferers to go to an emergency department for treatment. "Of more than 400 patients in the trial, we found those who received Tamsulosin passed their large kidney stones more often than the placebo group. "This means patients with large stones might not need more complicated treatments including surgeries, and this has potential to improve care and reduce costs. We're very excited because Tamsulosin treatment may also allow patients to be treated closer to home rather than needing referral to a major centre." EMF Australasia awarded more than $270,000 to support Dr Furyk's research, through its Queensland Research Program, which is funded by the Queensland Government Department of Health. EMF Australasia Chair, Associate Professor Sally McCarthy said this research had the potential to help millions of Australians suffering with this extremely painful condition. "It may also have implications for patients living in rural and regional areas, where access to urologists - the specialist doctors who treat this condition - can be limited." Up to 15 per cent of the Australian adult population and 1 in 11 people in the United States suffer from kidney stones, which range in size from a grain of sand to a pearl or even larger, and can be excruciating to pass through the urinary tract. Dr Furyk's research was recently published in the Annals of Emergency Medicine: http://www.annemergmed.com/article/S0196-0644(16)30364-X/abstract About the Emergency Medicine Foundation - EMF is an Australasian non-profit organisation funds innovative, evidence-based emergency medicine research that will improve clinical practices to save lives, as well as deliver significant economic benefits to the healthcare system. EMF runs two research grant programs - a national Rural and Remote program and a highly successful Queensland program - as well as a Research Support Network. The Foundation was established in 2007 with the support of the Queensland Government.
News Article | November 3, 2016
Millions of Australians suffering from kidney stones could soon get relief, with researchers discovering a prostrate treatment can also help ease the painful condition. Patients with kidney stones were treated with the drug Tamsulosin in an Emergency Medicine Foundation Australasia (EMF) funded clinical trial run across five Australian hospital emergency departments. Trial leader and specialist emergency medicine physician at The Townsville Hospital, Dr Jeremy Furyk, said Tamsulosin was normally used to treat an enlarged prostate, but the research team found the treatment could also assist the passage of large kidney stones in the urine. "Kidney stones are a bit of a mystery, occur frequently in the community and generally affect young, healthy adults," Dr Furyk said. "It can be extremely painful to pass these jagged little crystallized minerals and it's very common for sufferers to go to an emergency department for treatment. "Of more than 400 patients in the trial, we found those who received Tamsulosin passed their large kidney stones more often than the placebo group. "This means patients with large stones might not need more complicated treatments including surgeries, and this has potential to improve care and reduce costs. We're very excited because Tamsulosin treatment may also allow patients to be treated closer to home rather than needing referral to a major centre." EMF Australasia awarded more than $270,000 to support Dr Furyk's research, through its Queensland Research Program, which is funded by the Queensland Government Department of Health. EMF Australasia Chair, Associate Professor Sally McCarthy said this research had the potential to help millions of Australians suffering with this extremely painful condition. "It may also have implications for patients living in rural and regional areas, where access to urologists -- the specialist doctors who treat this condition -- can be limited." Up to 15 per cent of the Australian adult population and 1 in 11 people in the United States suffer from kidney stones, which range in size from a grain of sand to a pearl or even larger, and can be excruciating to pass through the urinary tract.
Croese J.,The Townsville Hospital |
Gaze S.T.,James Cook University |
Loukas A.,James Cook University
International Journal for Parasitology | Year: 2013
We recently completed clinical trials in people with diet-treated celiac disease who were purposefully infected with the ubiquitous human hookworm, Necator americanus. Hookworm infection elicited not only parasite-specific immunity but also modified the host's immune response to gluten. After infection, mucosal IL-1β and IL-22 responses were enhanced, but IFNγ and IL-17A levels and circulating regulatory T cells following gluten challenge were suppressed, and the adaptive response to gluten acquired a helper T cell type-2 profile. In this review, we briefly, (i) highlight the utility celiac disease offers autoimmune research, (ii) discuss safety and personal experience with N. americanus, (iii) summarise the direct and bystander impact that hookworm infection has on mucosal immunity to the parasite and gluten, respectively, and (iv) speculate why this hookworm's success depends on healing its host and how this might impact on a propensity to autoimmunity. © 2013 Australian Society for Parasitology Inc.
Schulze B.,The Townsville Hospital |
Ho Y.-H.,James Cook University
Techniques in Coloproctology | Year: 2015
Background: Ligation of intersphincteric fistula tract (LIFT) is a relatively new technique in the treatment of complex anorectal fistulas. As it spares the anal sphincter, rates of post-operative incontinence may be lower when compared to conventional treatment. To date, there have not been enough reports of long-term fistula recurrence rates. We performed a long-term follow-up study of 75 patients who underwent LIFT following seton drainage and partial fistulotomy.Methods: Only patients with complex cryptogenic anorectal fistulas were included. After seton insertion and partial fistulotomy, the tract was reviewed at 4 months for the absence of anorectal sepsis. Patients then underwent LIFT in a day surgery setting. Operative time, complications, recurrences and incontinence were evaluated.Results: Between May 2008 and June 2013, 75 patients [51 men, mean age 49.5 years, standard error of the mean (SEM) 1.4 years] were treated with a LIFT protocol. The mean operating time for LIFT was 13.2 min (SEM 1.5 min). Complications included minor bleeding, superficial wound dehiscence and perianal pain. At a mean follow-up of 14.6 months (SEM 1.7 months), there were nine (12 %) recurrences, diagnosed at a mean 9.2 months (SEM 2.7 months). They were treated with seton insertion followed by LIFT with biomesh or anorectal advancement flap, and there were no subsequent recurrences. Review of preoperative and post-operative continence scores revealed only one (1.3 %) patient with minor incontinence following LIFT. Recurrences were significantly related to fistulas with multiple tracts (p < 0.001).Conclusions: Our results suggest that the protocol of seton insertion and partial fistulotomy followed by LIFT is associated with a low recurrence rate comparing well with published results from studies involving other techniques and protocols for treating anal fistula. © 2014, Springer-Verlag Italia Srl.
Bhutia S.,The Townsville Hospital
The Cochrane database of systematic reviews | Year: 2013
In the initial treatment of venous thromboembolism (VTE) low molecular weight heparin (LMWH) is administered once or twice daily. A once daily treatment regimen is more convenient for the patient and may optimise home treatment. However, it is not clear whether a once daily treatment regimen is as safe and effective as a twice daily treatment regimen. This is the second update of a review first published in 2003. To compare the efficacy and safety of once daily versus twice daily administration of LMWH. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 2013) and CENTRAL (2013, Issue 4). Randomised clinical trials in which LMWH given once daily is compared with LMWH given twice daily for the initial treatment of VTE. Two review authors assessed trials for inclusion and extracted data independently. Five studies were included with a total of 1508 participants. The pooled data showed no statistically significant difference in recurrent VTE between the two treatment regimens (OR 0.82, 0.49 to 1.39; P = 0.47). A comparison of major haemorrhagic events (OR 0.77, 0.40 to 1.45; P = 0.41), improvement of thrombus size (OR 1.41, 0.66 to 3.01; P = 0.38) and mortality (OR 1.14, 0.62 to 2.08; P = 0.68) also showed no statistically significant differences between the two treatment regimens. None of the five included studies reported data on post-thrombotic syndrome. Once daily treatment with LMWH is as effective and safe as twice daily treatment with LMWH.
Smith J.,The Townsville Hospital
Neonatal network : NN | Year: 2013
The maintenance of a constant body temperature is important to all humans but even more so for newborn babies (neonates), especially those born pre-term. Because accurate measurement of body temperature is an important component of thermoregulation management in the neonate, a review of the literature was undertaken to determine the most appropriate method and site of temperature measurement in both the preterm and term neonate. The available evidence indicates that the axilla remains the most common place for temperature measurement.
Close B.R.,The Townsville Hospital
The American journal of emergency medicine | Year: 2012
A 23-month-old boy was brought to the emergency department of an adult and pediatric tertiary care center 1 hour after an inadvertent " double dose" of 120 mg flecainide (9.2 mg/kg). His electrocardiogram revealed sinus rhythm with a terminal R wave in aVR greater than 7 mm, a bifascicular block, and prolonged QRS and QTc intervals. A dramatic improvement in the bifascicular block and terminal R wave occurred after the administration of sodium bicarbonate. He was discharged after 36 hours with no complications. This case demonstrates that flecainide can cause significant cardiac conduction disturbances in doses much lower than previously described. All supratherapeutic ingestions should be assessed in hospital.
Edmondson M.C.,The Townsville Hospital |
Walker S.B.,Central Queensland University
Women and Birth | Year: 2014
Background: Pregnancy, birth and child rearing are significant life events for women and their families. The demand for services that are family friendly, women focused, safe and accessible is increasing. These demands and rights of women have led to increased government and consumer interest in continuity of care and the establishment in Australia of birth centres, and the introduction of caseload midwifery models of care. Aim: The aim of this research project was to uncover how birth centre midwives working within a caseload model care constructed their midwifery role in order to maintain a positive work-life balance. Methods: A Grounded Theory study using semi-structured individual interviews was undertaken with seven midwives who work at a regional hospital birth centre to ascertain their views as to how they construct their midwifery role while working in a caseload model of care. Findings: The results showed that caseload midwifery care enabled the midwives to practice autonomously within hospital policies and guidelines for birth centre midwifery practice and that they did not feel too restricted in regards to the eligibility of women who could give birth at the centre. Work relationships were found to be a key component in being able to construct their birth centre midwifery role. The midwives valued the flexibility that came with working in supportive partnerships with many feeling this enabled them to achieve a good work-life balance. Conclusion: The research contributes to the current body of knowledge surrounding working in a caseload model of care as it shows how the birth centre midwives construct their midwifery role. It provides information for development and improvement of these models of care to ensure that sustainability and quality of care is provided to women and their families. © 2013 Australian College of Midwives.